Edward Harrison is the founder of Credit Writedowns and a former career diplomat, investment banker and technology executive with over twenty five years of business experience. He has also been a regular economic and financial commentator in print and on television for the past decade. He speaks six languages and reads another five, skills he uses to provide a more global perspective. Edward holds an MBA in Finance from Columbia University and a BA in Economics from Dartmouth College.

It’s not a question of affordability but one of purpose. The affordability
issue is a technical detail that has to be addressed regardless of whatever
change is implemented. But first we have to decide why we want any change to
the current system.

Rather than make flippant retorts, you could try a substantive comment on
what type of reform we need if any.

Robert says 9 years ago

Very well, I’ll attempt a substantive reply to your emotional appeal, which is a departure from the other 99% of your posts that are grounded in fact and logic.

Since we both claim to be libertarian to one degree or another, we could probably talk what-if’s about the topic, charity vs. welfare, public vs. private, free market vs. central planning for hours, as libertarians seem to enjoy. However, any healthcare debate can only be framed in the context of the plans and arguments coming out of Washington right now. When you post videos of Al Franken and talk about how wrong it is for the richest country in the world to not provide some level of healthcare, while calling the money a technical detail, then you are speaking the same language as those currently in power and your post can only be read as an endorsement of their plans. This may be an unfair characterization but, to borrow another phrase from you, so what? That is the reality.

Here is my core problem with your point-of-view: the “technical detail” of affordability cannot be separated from a discussion about the morality of providing healthcare.

We have a deficit and debt that are so bad they defy comprehension by most people, which is probably the only reason they continue. Under Bush they were the worst in history and they are not projected to get that “good” again for a very long time, if ever. So we can argue the ethics/morality/emotional/logical arguments of “should we”, but the root is that we can’t do it. There is nothing beyond political rhetoric that points to any of the currently proposed plans being revenue-neutral or cost-saving. If we choose to implement any currently proposed plan we are making our children and those who have invested in America around the world pay in the future for our healthcare today. To me, you cannot discuss the morality of providing healthcare without talking about the morality of who pays for it. We’re not talking about rich vs. poor, we’re talking about us vs. our children.

You can make other arguments about the Constitution and the infringement on the rights of the people and the states under any of the proposed plans but it’s all moot if it can’t be paid for.

Since you asked, here are a few things I do support:

1) Allow tax deductions for individuals who pay for their own healthcare. There is a huge disconnect between the person paying the bill (the insurer) and the one getting the services (the insured). There is currently no incentive for the insured to reduce their consumption or to shop for better prices. This is a huge break in the supply/demand feedback loop that needs to be fixed if prices are to ever come down. Encouraging people to “own” their healthcare plan is a huge step in the right direction. They can shop for the appropriate level of coverage and, depending on the plan, would be incentivized to control cost and consumption. It also eliminates the people who lack healthcare because they have left one job and are waiting for benefits to begin at the new job.

2) Possibly end or reduce the ability for companies to deduct the costs of providing healthcare for it’s employees if it’s a company-owned plan. This goes back to the goal of getting people to own their own plan.

3) Allow people to purchase insurance across state lines. Competition is good.

4) Tort reform. Lawyers are bad.

4) Allow the government to define a healthcare plan that is equivalent to something in the EU or Canada, which would be similar to a Public Option here, call it “Eurocare” for lack of a better term. Allow private companies to offer that plan and offer protection against lawsuits as long as they follow the plan to the letter. It would necessarily limit expensive treatments, probably limit end-of-life care, and probably require longer waits- all things that can be clearly defined/measured from government healthcare in foreign countries. This should be a relatively cheap plan when many firms can compete with a well defined plan that partially limits the down side. This lets people try the Public Option without it being made into a permanent government fixture.

I’m sure I could come up with a few more if I sat down to really think about it but those four would be a good start. The important thing to note in the ideas above, they do not require any money from the government, our children, or the Chinese, and they do not impose anything upon those who want to control their own life without bureaucrats involved. They do not preclude future universal healthcare if they just don’t work out and they can be implemented tomorrow if there was the will to do it.

It is also worth noting that people do have basic heath coverage right now if they go to an emergency room. It’s not ideal but there are not people dying in the street.

Robert, thank you for the detailed response. Let me respond with a few comments. I may decide to take up these issues in a post, time permitting.

First, you speak of framing the question. I am not “speaking the same language of those currently in power” and my post is not an endorsement of their plans.

I want to put a narrow frame on the question as I believe Franken has done. He does not talk about Universal Coverage in the clip. His remarks are apropos because he wants to stick to the one question while the expert witness tries to conflate issues.

The question: Can we reasonably expect catastrophic insurance coverage for all to reduce medical bankruptcies as reflected in the dichotomy between existing systems which have it and our own, which does not?

The questions that fall from this for me are two-fold:
1. Even so, should a reduction in medical bankruptcies be a primary driver of initial healthcare reform efforts? If not, what should be?

2. If near ‘universal’ catastrophic coverage is a primary driver? Should we implement it irrespective of costs? if not, how do we control costs?

Without getting into the specifics of what you have said, I suspect you would answer the first question by saying something like “costs are not a technical detail but perhaps the key driving motivator of reform.” Fair enough, that is an issue (whether costs or coverage is the key driver of reform) that remains unresolved and is a major contributor to the failure of progress on reform. I would disagree as I think costs are important but not central.

For me, the question then is the second one: how do we make an imposition of catastrophic (and potentially maintenance) insurance cost effective? The Swiss system points in the right direction as does Douthat’s article. These represent market-based approaches which could be effective.

Anonymous says 9 years ago

Sorry to interrupt, but did anyone notice how incredibly hot the brunette sitting behind Senator Franken happens to be?

Ironist says 9 years ago

Mandatory catastrophic medical coverage would not require a 1,900 page bill that is an openly partisan effort. I think people do understand that very well, Dr. Harrison, which is why there is so much protest. The real purpose of the bill is deliberately masked but seems to be an effort to have government assume complete control of healthcare delivery. That’s enough to worry me and many others.